Coronavirus: What you need to know if you have HIV, diabetes or TB

If cases of the new coronavirus spread in South Africa, the country may be heading into uncharted territory — becoming the first country in the world to grapple with the new coronavirus and a high burden of HIV and TB.

HIV-positive people not on treatment and people with conditions such as hypertension and diabetes could be among the worst affected if cases of the new coronavirus spreads in South Africa.

On Tuesday, 10 March, Health Minister Zweli Mkhize confirmed South Africa now has 13 confirmed cases of the virus, officially named SARS Coronavirus 2 (SARS-CoV-2). The virus gets its name from its similarity to the virus responsible for the 2003 outbreak of severe acute respiratory syndrome in China. The World Health Organisation (WHO) has called the disease that SARS-CoV-2 causes COVID-19.

So far, eight of the country’s 13 COVID-19 cases are among a group of nine people who recently returned from an Italian skiing trip. The group is now in self isolation or quarantine and the health department is tracing anyone who might have been in contact with them.

The other five cases are from people who travelled back to South Africa from Germany, Austria, Portugal, Switzerland and Turkey.

Currently, the national health department doesn’t think the virus is spreading in South Africa but if in the future, it does, it may hit people with underlying health conditions such as HIV and TB, and who are not on treatment, the hardest — according to the heads of local HIV and TB research organisations. Similar risks may hold true for those living with other chronic illnesses.

HIV positive and on treatment? Then you have no cause for extra concern

Salim Abdool Karim is the director of the Durban-based Centre for the Aids Programme of Research in South Africa and a global health professor at Columbia University in the United States. Abdool Karim says that SARS-CoV-2 is too new to know much about its potential impact on people with HIV, but other viruses — such as measles or influenza — can give us a clue.

If those viruses are anything to go by, those with HIV, and who are not on treatment, will be among the most at risk.

“If an HIV-positive patient is on antiretrovirals, then their response will be pretty similar to what an HIV-negative patient’s response would be based on what we know from other infections,” he says.

Between 8 and almost 15% of people older than 70 who contracted the virus in China’s Hubei province died, according to a Chinese Center for Disease Control and Prevention analysis of more than 44 000 coronavirus cases released in February.

Now is the time to know your HIV status and start treatment’

“People on antiretrovirals need to make sure they’re taking their antiretrovirals and then I think there’s no reason to worry more than the general population,” Sanne told Bhekisisa. “What we’re worried about are people who are HIV positive and not yet diagnosed.”

In a statement earlier this week, Sanne explained: “Now is the time to know your status and start treatment.”

The agency admitted data on NCDs among coronavirus patients was not routinely collected. But among those infected with the virus who reported having diabetes, the death rate rose to about 7%. Meanwhile, an estimated 6% of Chinese coronavirus patients with high blood pressure died, the February data shows. This proportion increased to 11% among people with cardiovascular disease.

However, it’s unclear whether patients with NCDs also had any other risk factors, such as an older age, from the data.

Coronavirus and other chronic conditions

Nasheeta Peer is a senior specialist scientist with the South African Medical Research Council’s NCD Research Unit. She says it’s difficult to predict how people with NCDs such as diabetes, which weaken the immune system, might be impacted by the coronavirus.

Peer explains that people with diabetes will be at increased risk compared with the general population, “but if their diabetes is uncontrolled, which is possible even when taking medication for diabetes, then the risk may perhaps be greater”.

Data from Stats SA notes how diabetes is the second leading cause of natural death in South Africa after TB, with about 25 000 people who died in 2016. People with diabetes are three to four times more likely to develop TB, a 2010 research review published in the journal Tropical Medicine & International Health showed. This is why the country’s latest national TB plan recommends increasing TB screening among people with diabetes.

Director of the South African NCD Alliance, Vicki Pinkney-Atkinson, says if the new coronavirus begins to spread in South Africa, her main concern is people with NCDswho need medication, but could potentially put themselves at risk of contracting the virus by queuing in long lines at public clinics to do this.

“For the moment I’m lucky enough that I don’t have to go and stand in a long queue [to get my medication]” Pinkney-Atkinson says. “What will happen for those people who have to do it and travel on buses to get there and taxis to get there?”

Sethu Mbuli was a junior health reporter at Bhekisisa. She holds a BSc degree in ocean & atmosphere science and chemistry from the University of Cape Town, and in 2019, she completed her honours degree in journalism at Stellenbosch University. Mbuli has a background in broadcasting, having worked as a radio presenter and newsreader for Stellenbosch University's campus radio station, MFM 92.6, for over five years. She also worked as a radio presenter for HIP2B2, an initiative to teach maths and science to young people, started by Mark Shuttleworth. Mbuli was named a Queen's Young Leader 2018 and a News24 young Mandela of the future 2019 for her work raising awareness about albinism in South Africa.